NCCN Risk Reclassification in Black Men with Low and Intermediate Risk Prostate Cancer After Genomic Testing

Objectives To assess the utility of genomic testing in risk-stratifying Black patients with low and intermediate risk prostate cancer. Methods We retrospectively identified 63 Black men deemed eligible for active surveillance based on National Comprehensive Cancer Network® (NCCN) guidelines, who underwent OncotypeDx® Genomic Prostate Score™ testing between April 2016 and July 2020. Nonparametric statistical testing was used to compare relevant features between patients reclassified to a higher NCCN risk after genomic testing and those who were not reclassified. Results The median age was 66 years and median pre-biopsy PSA was 7.3. Initial risk classifications were: very low risk: seven(11.1%), low risk: 24(38.1%), favorable intermediate risk: 31(49.2%), and unfavorable intermediate risk: one(1.6%). Overall, NCCN risk classifications after Genomic Prostate Score testing were significantly higher than initial classifications (p=0.003, Wilcoxon signed-rank). Among patients with discordant risk designations, 28(28/40, 70%) were reclassified to a higher NCCN risk after genomic testing. A pre-biopsy prostate specific antigen of greater than 10 did not have significantly higher odds of HBR (OR:2.16 [95% CI: 0.64,7.59, p=0.2). Of favorable intermediate risk patients, 20(64.5%) were reclassified to a higher NCCN risk. Ultimately, 18 patients underwent definitive treatment. Conclusions Incorporation of genomic testing in risk stratifying Black men with low and intermediate-risk prostate cancer resulted in overall higher NCCN risk classifications. Our findings suggest a role for increased utilization of genomic testing in refining risk-stratification within this patient population. These tests may better inform treatment decisions on an individualized basis.